Evidence-Based Practice for Nurses

reliability of the estimate, in this case, effect size (Cooper et  al., 2009). Due
to the sophisticated analysis, a meta-analysis is considered to be a very high
level of evidence.

Network meta-analysis, also known as multiple treatments meta-analysis
or mixed treatment comparison meta-analysis, is a method used to assess the
comparative effectiveness of experimental treatment among similar patient
populations that have not been compared directly in a randomized clinical
trial. Unlike traditional meta-analyses, which summarize the results of tri-
als that have evaluated the same treatment/placebo combination, network
meta-analyses compare the results from two or more studies that have one
treatment in common (Bafeta, Trinquart, Seror, & Ravaud, 2013; Cipriani,
Higgins, Geddes, & Salanti, 2013; Lumley, 2002). Unlike the systematic re-
view, the author obtains both published and unpublished evidence. Authors
may even contact researchers for their data to perform the analysis. Meta-
analyses are critical because information may be used to guide clinical practice
decision making and direct the development of future research strategies
(Moore, 2012).

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses
(PRISMA) guidelines were created to help authors improve the reporting
of systematic reviews and meta-analyses (Moher, Liberati, Tetzlaff, & Alt-
man, 2009). PRISMA consists of a 27-item checklist and a flow diagram. For
each checklist item, this document contains an example of good reporting,
a rationale for its inclusion, and supporting evidence, including references,
whenever possible.

In nursing and other practice disciplines, an important kind of synthesis
is practice guidelines. They are “systematically developed statements to assist
practitioner and patient decisions about appropriate health care for specific clini-
cal circumstances” (Institute of Medicine [IOM], 1990, p. 8). These guidelines
are systematically created by a group of experienced experts and key affected
persons who read, critique, and prioritize the pertinent evidence. Practice
guidelines have been introduced into practice for several reasons. These con-
sensus recommendations are developed for use in practice to improve patient
and system outcomes. These tools seek to reduce variations in practice, resulting
in more consistent care delivery by those who use the guidelines. Guidelines
also enhance efficient use of resources, which frequently results in reducing
the cost of care delivery. Guidelines should have the following characteristics
(IOM, 2011):

» “be based on a systematic review of the existing evidence;

» be developed by a knowledgeable, multidisciplinary panel of experts and rep-

resentatives from key affected groups;

KEY TERM

practice guidelines:

Systematically

developed

statements to

assist healthcare

providers with

making appropriate

decisions about

health care for

specific clinical

circumstances

12.1 The Pyramid of the 5 Ss 317